This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. he specific aims of the original proposal were unmodified and remain as follows: Specific Aim 2: To promote physician awareness and patient lifestyle interventions to enhance treatment and outcomes of CV risk factors associated with Metabolic Syndrome in hypertensive African Americans. Specific Aim 2a: To determine the baseline state of awareness, treatment and control of the Metabolic Syndrome among community based practitioners, and provide a physician feedback and education intervention on provider diagnosis and treatment of CV risk factors associated with the Metabolic Syndrome in hypertensive African Americans. We will describe practice patterns in primary care settings, and compare the percentages of hypertensive patients who are treated with JCN7 and ATPIII guidelines and assessed for the Metabolic Syndrome before and after structured performance feedback and education(audit feedback). Specific Aim 2b: To develop and evaluate the effects of a culturally sensitive self management lifestyle intervention (LSI) on health behaviors, clinical outcomes and psychosocial factors in hypertensive AA with CV risk factors associated with the Metabolic Syndrome. 2b1. Primary aim To determine if participants who receive the LSI intervention demonstrate improved health behaviors over participants randomized to usual care (UC) as exhibited by: increased exercise tolerance test (treadmill), increased PA levels (Metabolic Syndrome-h/week from CAPS Questionnaire);improved dietary patterns (Block Questionnaire;3 day food records), and improved medication compliance (Hill-Bone Questionnaire). 2b2. Secondary aim: To determine if participants who receive the LSI demonstrate improved clinical outcomes over those randomized to UC as exhibited by: lower systolic and diastolic BP, lower weight, improved serum total cholesterol, high density lipoproteins, and triglyceride levels, and improved metabolic and inflammatory profile (fasting glucose, 2 hour glucose, fasting insulin, HOMA, CRP). 2b3. Tertiary aim: To determine if participants who receive the LSI experience improved health related quality of life (HRQOL) and psychosocial factors over those receiving UC as exhibited by improved overall physical and mental functioning (SF-36), lower perceived stress, lower depressive symptoms, increased social support, increased diet and PA self efficacy, and increased stage of change for PA. We proposed to carry out the study in three phases. Phase I involves a detailed assessment of hypertensive care among the Community Physician Network (CPN) practices with efforts made to standardize care. Specific aim 2a is addressed in phase I. In phase II, which addresses aim 2b ( "develop and evaluate a culturally sensitive self-management lifestyle intervention on health behaviors") focus groups to assess concordance of planned intervention to expectations and acceptance, and a pilot study were conducted, Phase III is the clinical study involving recruitment and randomization of patients to usual care or the lifestyle intervention with baseline and follow-up data collection and analysis.